Contact tracing of TB patients at Birmingham Chest Clinic

1. Contact tracing of TB patients at Birmingham Chest Clinic Kinza Saeed

2. Contact Tracing at Birmingham Chest Clinic • In the UK TB has risen by more than 1/3 in the past decade • In parts of Birmingham TB is at the level of high-incidence countries • Around 400 active TB cases every year • Over 2500 contacts every year

3. Aims and Objectives • Aim: Evaluate contact investigations at Birmingham Chest Clinic • Objectives: • To outline the existing pathway for contact investigations and compare practice to national guidelines • To assess the outcomes from contact tracing • To make recommendations on how the contact investigation pathway can be improved to increase the completion rate

4. Methods and Materials • Randomly selected a sample of 345 TB contacts referred in 2012 • Information on if the contact is: - respiratory or non-respiratory - household, non-household or congregate - assessments - final outcome

5. How are contacts assessed? • The Birmingham Chest Clinic has local protocols of contact investigation, adapted from the National Institute for Health and Clinical Excellence (NICE).

8. Assessment episodes of TB contacts aged 35 and under • 52% tested for latent TB as first assessment • 33% of contacts DNA their first assessment • 89% completed contact tracing • 75% of respiratory contacts followed correct protocol • 91% of non-respiratory contacts followed correct protocol • NOTE Data are number of contacts (%). CXR, chest X-ray; IGRA, interferon-gamma release assay; TST, tuberculin skin test; DNA, did not attend.

9. Figure 6 Outcomes of contact tracing for contacts aged 35 years and under in respiratory vs. non-respiratory index cases. Outcomes of contact tracing for contacts aged 35 and under • 44% of respiratory contacts and 62% of non-respiratory contacts had a positive yield • 35% of respiratory contacts defaulted • 42% of non-respiratory contacts defaulted • NOTE Data are number of contacts. An outcome of other was given for contacts who transferred out of the area or declined invitation for contact tracing.

10. Figure 7 Assessment episodes of TB contacts aged over 35 years Assessment episodes of TB contacts aged over 35 • 50% of contacts received a chest X-ray as a first assessment • 21% of contacts DNA their first assessment • 97% completed contact tracing • 86% of respiratory contacts followed correct protocol • 95% of non-respiratory contacts followed correct protocol • NOTE Data are number of contacts (%). CXR, chest X-ray; IGRA, interferon-gamma release assay; TST, tuberculin skin test; DNA, did not attend.

11. Figure 8 Outcomes of contact tracing for contacts aged over 35 years in respiratory vs. non-respiratory index cases. Outcomes of contact tracing for contacts aged over 35 • 45% of respiratory contacts and 29% of non-respiratory contacts had a positive yield • 33% of respiratory contacts defaulted • 19% of non-respiratory contacts defaulted • NOTE Data are number of contacts. An outcome of other was given for contacts who transferred out of the area or declined invitation for contact tracing.

12. Conclusion • The mode first assessment for each contact type was in accordance to the national guidelines • Contacts to respiratory cases have lower adherence to protocols compared to non-respiratory contacts • Contacts require up to five appointments for protocol completion to approach 90%. • Approximately 20-30% fail to attend the first 2 scheduled appointments • 34% of contacts did not complete protocol or defaulted